Therapeutic Communities: A Three Country Comparison

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The increasing prevalence of drug addiction and its public health consequences, particularly the spread of HIV/AIDS around the world, requires international collaborative research, training and technical assistance to improve our understanding of addiction, its prevention and treatment. This proposal, in response to NIDA PAS-03-023, International Research on Drug Addiction, will assemble an international network of scientists to foster research, training and the exchange of scientific information by working collaboratively on a study of therapeutic community (TC) treatment in three countries. The study will describe client, program and organizational characteristics of three large TC programs, one each in China, Thailand and the US. The degree to which these programs show fidelity to established TC best practices will be measured. Data collected from 1610 clients will be used to examine the relationship between elements of fidelity and client retention, progress in treatment and proximal (at discharge) treatment outcomes. The study will produce culturally-specific translations of data collection instruments and will examine the unique cultural characteristics pertinent to effective treatment in each location. By treating the whole person TCs address the full spectrum of substance abuse related problems. As confirmed by NIDA's research (NIDA Research Report - Therapeutic Community: NIH Pub. 02-4877, Aug. 2002). http://www.drugabuse.gov/ResearchReports/ Therapeutic/default.html, TC treatment, if successful, is a cost-effective approach to treating a wide range of health problems. The assembled community of international scientists will: 1) work closely with the PI in the conduct and management of the research; 2) evaluate the cultural context in which each TC operates; 3) provide technical assistance/ training in program refinement to the TCs in China and Thailand; 4) disseminate study findings in the US and abroad that serve to improve treatment effectiveness; and 5) develop future research initiatives in the international settings. The research is significant in three ways: 1) findings will inform international programs regarding best practices for client engagement, retention and progress in treatment; 2) the research will strengthen the capacity to fight the twin epidemics of drug abuse and HIV/AIDS in the critical focal points of China and Thailand; and, 3) continued initiatives emanating from this new international research community may ultimately modify, improve and expand global treatment services.